This invention is directed to a technique for providing automated direction to nurses for dispensing medication to patients and, more particularly, to a technique for storing patient information and medication-dispensing instructions in a main computer from which that information and instructions pertinent to designated patients are retrieved and transferred to a portable, hand-held unit that is carried along by the nurse on medication rounds to direct the task of dispensing medication.
Hospitals now use a system for dispensing medication to patients which is prone to error. It is a multi-step, cumbersome, labor intensive, repetitive, and time consuming approach which relies on hand-written instructions, hand-written reports, periodic hand-written changes by way of erasures and/or additions, verbal communication, and manual sorting of large amounts of data. Specifically, the overall process includes the following steps.
At admission, the patient is questioned to obtain personal information as well as his medical history. After a medical examination, the doctor completes an order sheet which lists the drug, dosage, route (e.g., IV, injection, oral) and frequency in which the drug is to be given. A nurse at the main nursing station takes the order sheet and combines it with any other information she has about the medical history of the patient such as allergies, contra-indications, and the like, to prepare a medication summary record for that patient. When a medications nurse comes on duty, a set of patients is assigned to that nurse. The nurse pulls the medication summary records for these patients and prepares handwritten notes to assist in correctly dispensing the proper medications on the next medication round. As the nurse dispenses the medication, the notes kept by the nurse are marked according to what occurred. For example, the patient may have refused the medicine, or he may have been away from the room in which case the medication was missed. Upon returning to the main nursing station, the nurse uses the notes to update the medication summary record. These notes are then utilized by the same nurse or another nurse for the next medication dispensing round.
It can readily be seen that each time medication information is written by hand, it is potentially a source of error. With the above-described approach, such information must be written and rewritten many times over. The medication summary record is initially written. The medication nurse prepares notes from this record. Also, the record is manually updated when a round is completed. This is repeated for each and every medication dispensing round in each and every day. Thus, the information is susceptible to error in the course of such multiple hand-written transfers of information. Furthermore, the instructions ordered by the physician are subject to change periodically. These changed instructions are typically written at the bottom of the medication summary record. This can be an extremely messy operation, complicates the task of reading and understanding the medication summary record and is a potentially significant source of error. Moreover, a medication summary record is good for no longer than 7-10 days because of the limited space on the sheet. Thus, it has to be recopied for the next period. Finally, medication instructions ordered by a physician are only good for a certain number of days. The instructions must be renewed or cancelled at the termination of that time. This information must be entered manually again. The overall system can be, therefore, messy, awkward, time consuming, and, most importantly, far from the reliable system which one expects to exist when so much is at stake.
This system replaced and updated a prior method in which a colored card technique was used which had a different colored card related to a particular time of day. The information on cards of a particular color was, therefore, restricted to an assigned time of day. Therefore, confusion about medication dispensing times is minimized. However, much of the criticism applied to, and the dissatisfaction with, the above-described system was applicable to this approach as well.
Some hospitals have installed a more modern computerized system which stores patient information as well as the doctor's medication dispensing instructions in a data base. The medication nurse can access the data base to retrieve pertinent information about her designated set of patients from which she prepares her own notes for carrying out the task. It may also be possible to obtain a set of medication dispensing instructions from the computer itself. However, even this approach is unsatisfactory because during rounds the nurse makes hand-written notes regarding the dispensation of the medicines, as explained above. With this method, medication can be given to the wrong patient, missed, or passed over. At the completion of the rounds, the nurse must take those notes and either update the data base or convey the information to someone else for updating the data base, thereby exposing a further possibility of posting error. The hand-written operations involved at these stages of the overall task can also be significant sources of error. Specifically, if the information is not written or recognized properly, then a missed medication may not be noticed. Also, medication might have been dispensed but listed as missed in which case unnecessary medication might be administered to the patient. Furthermore, the system does not include any check on the nurse's actions to monitor during the actual rounds that the correct medication is being dispensed. For example, in reading down the list of notes kept by the nurse, it is possible to inadvertently interchange the medication instructed for one patient with that of another and, consequently, the wrong medication will be administered.
A further deficiency of these prior art approaches lies in the incompatibility between the instructions for dispensing medication and the task of obtaining medication from the hospital pharmacy. Forms must be filled out and conveyed to the pharmacy where, possibly, other forms must be completed to retrieve the requested medications and ship them to the correct hospital floor. Further forms must be completed for inventory control and for billing. Each of these requires multiple steps involving hand-written operations, all of which are potential sources of error. Moreover, efficiency is compromised and this tends to raise hospital costs.